Remote RN: Utilization & Discharge Review Specialist
Centene Management Company LLC
- Remote job
Centene Management Company LLC is seeking a licensed nurse to perform concurrent reviews for Ambetter members in Georgia. This fully remote role follows a Monday–Friday schedule 8am–5pm ET and supports medically necessary care decisions. The position requires RN/LPN licensure with nursing education and 2+ years acute care experience; knowledge of utilization management is preferred. This role offers remote flexibility and contributes to value-based care. #J-18808-Ljbffr Centene Management Company LLC
- ...WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure compliant... ...team-oriented environment. Requirements include active RN or LVN licensure, a minimum of two years in utilization...Remote workWork at office
$65k - $85k
...Concierge Home Care | Remote Opportunity | Growth Opportunities | Increased Earning Potential At Concierge Home Care, we are growing and looking for an experienced Utilization Review Specialist (RN) to join our remote home health team. This role is ideal for an RN with...Remote workMonday to FridayWeekend workWeekday work- ...seeking experienced nursing professionals to review medical records and ensure appropriate... .... Candidates must have a valid California RN license and at least two years of clinical... ...degree in a related field. The position offers remote work with emphasis on critical thinking...Remote work
$62k - $70k
...position is to ensure that the utilization process is thorough,... ...manner Completes peer to peer reviews with insurance MDs to advocate... ...from the front door through discharge Partners WithManager and Director... ...‑sponsored benefits. #LI-REMOTE Please note that this role...Remote workFull timeLocal area$40k - $50k
...Full-time Description Utilization Review Specialist Full-Time- must be able to work a few weekends per month Location: Remote Preferred Residence: Candidates residing... ...criteria, continued stay requirements, and discharge planning. Maintain accurate,...Remote workFull timePart timeWork at officeWeekend work$60k - $75k
...Full Time Office/Clerical Remote, Birmingham, AL, US 14 days... .... We are seeking a Utilization Review Specialist to add to our dynamic team... ...regarding anticipated transitions, discharge planning, and changes in... ...certification, such as RN, LPN/LVN, LMSW, LPC, CADC,...Remote workFull timePart timeWork at office$62k - $70k
...position is to ensure that the utilization process is thorough,... ...manner Completes peer to peer reviews with insurance MDs to advocate... ...from the front door through discharge Partners with Manager and Director... ...-sponsored benefits. #LI-REMOTE Please note that this role...Remote workFull timeLocal area- Centene Corporation is seeking a remote nurse reviewer to perform concurrent... ..., documenting findings and discharge plans in health systems. The... ...candidate has an active RN or LPN license, 2-4 years in... ...with Medicare/Medicaid and utilization management processes. #J-1...Remote job
- ...Job Description A Day In The Life The Utilization Review Specialist (RN) is responsible for ensuring appropriate utilization of... ...eligibility for post-acute services. Apply Interqual/Milliman discharge screens to assess patient’s readiness for a lower level...Full timeWork at officeWeekend work
- ...Description Job Description Position Summary The PACE Utilization Review Specialist – RN oversees clinical utilization management for... ...inpatient and post-acute length of stay and coordinate timely discharge planning. Review, develop, and implement utilization...Work at office
- ...RN Utilization Review Specialist | Case Management | Nights Case Mgt/Social Work Back to Search Job Details Career area: Case Mgt/Social... ...assisting with appeals as needed, communicating discharge notifications to payers, and closing authorizations appropriately...Hourly payFull timeLocal areaShift workNight shift
- ...quest for better? Job Description The RN Utilization Specialist reflects the mission, vision, and... ...utilization. The RNUS through regular reviews and audits and collaboration with the... ...May participate in interdisciplinary discharge planning rounds to facilitate communication...For contractorsCasual workWork at officeLocal areaRelocation package
- ...States is seeking an Inpatient Utilization Management Clinician to... ...treatment, and support discharge planning across care teams. This fully remote, full-time role requires an active RN license, nursing degree, and... ...to ensure timely reviews, document outcomes, and maintain...Remote workFull time
- ...Mass Digital Health is seeking a Clinical Reviewer LPN for a work-from-home position. The role involves performing retrospective medical... ...in a relevant medical setting, and the ability to work in a remote environment. Comprehensive benefits are provided, including medical...Remote workContract workWork from home
- ...Job Description: Ascension Texas Utilization Management Department (Fully Remote)Job Summary:• Provides health care services regarding admissions, case management, discharge planning and utilization review.Responsibilities:• Reviews admissions and service requests within...Remote work
- ...Recovery Unplugged is seeking an experienced Utilization Review Specialist to join our team. This remote, part-time role focuses on obtaining and maintaining insurance authorizations, communicating with managed care organizations, and collaborating with clinical teams....Remote workPart timeWeekend work
- ...and substance use treatment, the full-time Behavioral Health Utilization Review Specialist will verify benefits, complete prior authorizations, and support medical necessity criteria while working remotely. Key responsibilities Verify insurance benefits, eligibility,...Remote workFull time
- ...treatment of addiction and mental health issues, the full-time Remote Utilization Review Specialist will manage pre-authorizations and concurrent reviews,... ...School diploma or equivalent with a state license (e.g., RN, LPN, LCSW, LMHC) preferred Minimum of three years'...Remote workFull time
- ...to the LTSS department. RN will be responsible for... ...and concurrent review. Provides monthly telephonic... ...of treatment setting by utilizing the applicable medical... ...proactive planning for discharge planning. Facilitates member... ...Info: *possible remote opportunity after training...Remote workContract workMonday to FridayFlexible hours
$50k
...lives of patients and their families What to Expect (Job Responsibilities) Complete pre-authorizations, concurrent reviews, and internal utilization review assessments Consult with the multidisciplinary treatment team to gather necessary information for concurrent...Remote work$38.66 - $58.32 per hour
...Utilization Review RN Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future... ...Every day you will conduct admission, concurrent, and post-discharge reviews, ensuring compliance with utilization review...Remote workFull time- ...Your future role at a glance Location: Remote Department: Ascension Care Management Insurance - Utilization Review Schedule: Day Shift | PRN until 12/31/26... ...management of claim denials or appeals. Strategic Discharge Coordination: Evaluate and coordinate...Remote workReliefLocal areaDay shift
$30 - $45 per hour
...consulting agency is seeking an Operations Specialist III for a contract opportunity in Long... ...along with experience in Epic EHR and Utilization Review. The selected candidate will perform... ...program metrics. This position is remote and offers a pay range of $30-$45 per...Remote workHourly payContract work- ...and streamlined manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR Specialist will utilize his... ...a cohesive and rewarding environment. This is a fully remote or office/home hybrid position. Your Responsibilities:...Remote workWork at officeFlexible hours
- ...Utilization Review (UR) Specialist Location: Open to candidates near Wyomissing PA & Chadds Ford PA (Hybrid / Remote Eligible) Job Type: Full-Time Schedule: Monday – Friday Diversified Treatment Alternative Centers (DTAC) is seeking a detail-oriented and experienced...Remote workFull timeMonday to FridayFlexible hours
- ...Broward Pace Program sites. Job Title: Utilization Review RN Job Summary The Utilization RN... ...admission, continued stay, and discharge reviews for inpatient, observation, post... ...Environment Work Conditions ~ Remote role with reliable high-speed internet...Remote workFull timePart timeWork at officeLocal areaWeekend workAfternoon shift
- ...UofL Health in Louisville, KY seeks an experienced Utilization Review RN to support the Utilization Management function. You will assess medical necessity for admissions and continued stay, coordinate with physicians and case managers, and document in Case Management Software...
- ...A leading healthcare staffing firm is seeking a Utilization Review RN in Syracuse, NY. The role involves conducting utilization management activities, certification reviews, and collaborating with healthcare providers. Candidates must have an RN License in NY and at least...Monday to Friday
- ...Excellus BCBS in New York seeks a Utilization Management professional to coordinate behavioral... ...services for members. You will perform clinical reviews, ensure medical necessity, and... ...Requirements include an associates degree with NYS RN license and at least three years of UM...Work at office
- Spectrum Billing Solutions is seeking an ABA Utilization Review Specialist to review clinical information and obtain authorizations for ABA and related services. This role supports remote or office/home hybrid work and emphasizes attention to medical necessity and HIPAA...Remote jobWork at officeWork from home
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